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Accountable Care Organizations: A New Paradigm for Health Care Delivery?

Friday, May 13, 2011

In addition to expanding coverage to 32 million previously uninsured Americans, the health reform law of 2010 aims to improve the health of the population and the quality of health care delivery, while reducing costs. One tool to pursue these goals is the creation of a national voluntary program for accountable care organizations (ACOs). The law authorizes Medicare, beginning next year, to contract with accountable care organizations in a Medicare Shared Savings Program. ACOs provide financial incentives to improve the coordination and quality of care for Medicare beneficiaries, while reducing costs.

The Centers for Medicare and Medicaid Services (CMS) has released a proposed rule for implementing the new program, laying out requirements for groups of providers to qualify as ACOs and methodologies for monitoring and assessing ACO performance and distributing shared savings.

The ACO provision and the proposed rule raise many questions. How can health care providers organize to provide more patient-centered, coordinated, accountable care? How will the new program affect the relationships among primary care providers, specialists, and hospitals? Will coordination among providers mean concentration of market power and higher prices? What lessons can be learned from existing ACOs about achieving better care, better health, and lower costs? What other issues need to be addressed before the CMS proposed rule on the Medicare Shared Savings Program for ACOs becomes final?

To address these and related questions, the Alliance for Health Reform and The Commonwealth Fund sponsored a May 13 briefing. Panelists were: Rick Gilfillan, CMS Center for Medicare and Medicaid Innovation; Susan DeVore, Premier Healthcare Alliance; William Jessee, Medical Group Management Association; and Mark McClellan, Engelberg Center for Health Care Reform at the Brookings Institution. Stuart Guterman of Commonwealth and Ed Howard of the Alliance co-moderated.

Stuart Guterman of The Commonwealth Fund describes how Accountable Care Organizations can help lead to a high performance health system. From the May 13 briefing cosponsored by The Fund.

Richard Gilfillan, acting director of the Center for Medicare and Medicaid Innovation at CMS, discussed the proposed characteristics of Accountable Care Organizations at the May 13 briefing cosponsored by The Commonwealth Fund.

Susan DeVore, president and CEO of the Premier health care alliance, discussed what hospitals like and don't like about the proposed rules governing Accountable Care Organizations. From the May 13 briefing cosponsored by The Commonwealth Fund.

William Jessee, MD, of the Medical Group Management Association, offered physicians' suggestions for improving Accountable Care Organizations. From the May 13 briefing cosponsored by The Commonwealth Fund.

Mark McClellan, MD, of the Brookings Institution, discussed how to make Accountable Care Organizations successful at the May 13 briefing cosponsored by The Commonwealth Fund.

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